


Emily

by powerhouseofthe_cell



Category: The Good Doctor (TV 2017)
Genre: American Sign Language, Auditory Processing Disorder, Autism, Canon Autistic Character, Communication Disorder, Gen, Patient Fic, Plays out like an episode basically, patient
Language: English
Status: Completed
Published: 2018-01-31
Updated: 2018-01-31
Packaged: 2019-03-11 18:39:21
Rating: General Audiences
Warnings: No Archive Warnings Apply
Chapters: 1
Words: 4,224
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/13530234
Author URL: https://archiveofourown.org/users/powerhouseofthe_cell/pseuds/powerhouseofthe_cell
Summary: In which a patient can't speak, the interpreter is out of town, and Shaun Murphy is the only person in the hospital who seems to know sign language.





	Emily

It’s September 3rd, 2018. For most, this means spending a lazy Labor Day with friends and family, perhaps barbecuing or going for one last swim. But for the surgical residents of San Jose St. Bonaventure Hospital, it’s hour 10 of a 20 hour shift. Claire’s curls were slowly falling from her ponytail and into her face, where she brushed them back without caring how it looked. Jared had cream cheese from his bagel on his sleeve, and even Shaun wasn’t looking as clean-cut as he did when he arrived that morning.

Melendez approached the three residents with a file in hand. “We’ve got a young female, possibly early 20s, admitted with shortness of breath. EMTs listening to her chest noticed a murmur.” Jared took the file and opened it.

“Congenital heart defect?” He scanned the single paper inside the folder, noting patient vitals.

“We don’t know. We have no medical history, or even a name.” Melendez sighed and leaned against the nurse’s station. Claire raised her eyebrows.

“Why not? There is nothing in the report about a loss of consciousness.” She turned the page over, but the other side was blank.

“She’s awake, but she can’t talk. The nurses said they think she’s deaf, and it looks like she’s trying to sign something, but our regular interpreter is out today for Labor Day.” Jared opened his mouth to speak but was cut off. “The emergency interpreter is currently with another patient, and it doesn’t seem like she’ll be done for a while.” Claire then tried to ask a question, but was also cut off. “And no one in this entire damn hospital can seem to locate the information for a video interpreter. Until we can find someone, we can’t talk to this girl.” Claire looked at the file again, looking for any information she may have missed. Shaun piped up from the back of the group.

“I know American Sign Language.” He looked up for a moment before his eyes darted back to the floor. Melendez stood up straight.

“You do?” Shaun nodded once, then once again like he was reassuring himself.

“Yes, yes I do. One of my foster brothers was deaf and he taught me ASL.” Now, he had everyone’s attention. 

“Shaun, I didn’t know you were a foster kid.” Claire put the file down on the counter and gave him her full attention. Melendez didn’t wait for his answer, however.

“Yeah great story, the three of you get a full and detailed history from this girl. Also, get any family contact information you can, if she loses consciousness we need someone who can consent.” He sent the three off to the patient’s room.

-

Claire knocked on the doorframe of the patient’s room, and was a bit startled when the young girl looked up at the noise. The girl was no older than 18 or 19, and had long brown hair. She also had a brilliant blue nose ring and a tattoo of what looked like birds across her collarbone. Claire let Shaun go in front of the group so he could introduce them.

Shaun signed while he spoke, “Hello, my name is Dr. Murphy. The ER nurses noticed you were signing, but there are no interpreters available. What’s your name?” His signing was slow and deliberate, like his speech. His signing space was small, his hands only moving in the immediate area in from of him.

The girl lit up when Shaun started to sign. She sat up straighter in the bed and worked to untangle her hand from the O2 monitor before responding, with Shaun interpreting as she signed. “My name is Emily. I’m really happy they found someone who could sign. I’ve been stuck without any way to communicate for over two hours.” Claire sat down on the stool next to the bed, with Jared taking the chair and Shaun standing behind the two so his hands were still in Emily’s line of sight.

Claire was the first to start asking questions. She first looked at Shaun, then remembered to look at Emily when speaking. “I’m really sorry you haven’t been able to speak with anyone. Are you deaf? And how old are you? Is there someone we need to contact, like maybe your parents?” She glanced down at the clipboard in front of her, ready to begin writing Emily’s information. Shaun watched as the girl signed, interpreting slowly so as to get the intended meaning correct.

“I’m 18. My parents are in Tanzania right now for a work trip, so I don’t really know how to get in touch with them. Someone from the embassy might be able to find them, but I’m not sure. And I’m not deaf. I have auditory processing disorder with developmental verbal dyspraxia.” Because she had to spell each word, it took a full thirty seconds for Emily to sign and Shaun to interpret her diagnosis. Claire wrote this down while Jared continuing questioning.

“And could you explain what that means? We’re surgical residents, so we aren’t communication disorder experts.” Shaun opened his mouth to explain but Emily’s hands beat him to it.

“Auditory processing disorder is a developmental disorder that basically stops my brain from correctly interpreting sounds. It means that while I can physically hear you speaking, I can’t translate that sound into words.” Shaun interpreted the rest of her sentence before chiming in.

“APD is very common in people with autism.” 

Emily brightens and snaps her pointer finger off her chin and to her closed fist. “That’s right! Most of my friends with APD are also autistic, but I’m not.” Claire was still writing, so Jared continued with the questions.

“What about the other thing? The dyspraxia?” Shaun slowly spelled dyspraxia, his fingers getting tangled by the time he got to ‘i’. Emily’s mouth quirked in a small smile.

“Developmental verbal dyspraxia. Along with the APD, my brain can’t figure out how to connect the communication neurons to my mouth. Instead of trying years of therapy and treatments that might not be successful, especially since I can’t understand what people say, my parents just decided to have me sign instead. It’s what I’m most comfortable with anyway.” She shrugged when she was done signing, shaking her fingers a bit to let Shaun know she was done. He finished interpreting before reading the chart again over Claire’s shoulder.

Shaun read the extremely brief patient summary and began speaking and signing simultaneously. His foster brother always hated when people did that, but Shaun saw it as the only way to be understood by everyone in the room. “You were admitted with acute shortness of breath. Has that ever happened before?” Shaun moved his hand very slightly over his shoulder for ‘past’.

Emily shook her head. “Not that I can remember.” She coughed a bit and picked at the blanket before looking back up. Claire finished writing and started with the next question,

“Do you have any preexisting medical conditions that you haven’t already told us about? Congenital heart defects? Cystic fibrosis? Asthma? Anything like that?” Shaun struggled to fingerspell the questions, but Emily just nodded encouragingly. 

“No. Nothing. I don’t even think we have anything that runs in my family besides colon cancer.” Claire nodded and wrote this under ‘family history’.

“Okay, well we are going to take some labs and I’ll schedule you for an EKG and Echo. Do you mind if I listen to your chest first though?” Emily smiled and waved her over.

Claire stood from the stool, pushing it behind her, and moved to stand next to Emily. Jared moved to the other side and Shaun stood at the foot of the bed so he would be easily seen. Starting with the lungs, Claire placed her stethoscope under the girl’s gown and listened.

“I don’t hear any wheezing. Lay back and I’ll listen to your heart.” She placed the metal on Emily’s chest and was startled by what she heard. She turned to speak to Jared and Shaun, but Shaun interpreted anyway.

“That’s a really unusual murmur. Sounds like a truck.” She stepped away from the bed. “Here, you listen. EMT didn’t mention it was this loud.” Claire and Jared swapped places, and he leaned forward to listen to the girl’s heart.

“I’ve never heard anything like this.” He turned to the patient. “We’ll get a nurse in her to draw your labs, and someone to do the echo right away.” He gave his best reassuring smile. 

Emily didn’t look convinced, but signed ‘thank you’ and gave a little wave to Shaun as they left. 

Outside the room, Claire set down her clipboard and crossed her arms. “She’s got a serious defect in her heart. Atrial septal defect maybe?” She handed the clipboard to a nurse to input into the computer.

Shaun shook his head. “No. Atrial septal defects don’t sound like trucks. She could have aortic valve stenosis.” He asks for lab and echo request forms from the nurse’s station and begins filling them out. Jared adds to the differential as well.

“She’s too young and healthy to have a valve disorder, but I don’t see how this could be a congenital heart defect. There’s no way anyone could have missed a murmur like that.”

Claire begins walking towards the elevator to update Melendez on Emily’s condition, and the boys follow. “They could if they weren’t focused on her heart. Assuming that every doctor Emily has ever seen has been solely focused on her communication disorder, it’s possible that it has been overlooked for 18 years. If we could get in touch with the parents, we’d know more about her medical history.” The elevator closed behind the three, and Jared pressed the button for the fourth floor. 

They meet Melendez at the nurse’s station, where he is talking to Dr. Andrews about the follow-up for a former patient. The residents wait until Andrews leaves before descending upon their superior. Jared begins filling him in.

“The girl’s name is Emily. She’s 18, and she’s not deaf; she has a communication disorder.” Melendez shakes his head.

“Okay, so what does that mean?” Shaun decides to take his turn.

“Her hearing and vocal cords are intact; the issue is with her brain. She can’t understand or speak English, so she uses sign language.” He hums under his breath. “She also has a heart murmur that sounds like a truck.” Melendez furrows his eyebrows.

“A truck? Her heart sounds like a truck?” He sounds incredulous, and Claire steps in.

“It’s a really loud, almost mechanical murmur. I’ve never heard anything like it. We ordered labs and an echo, but according to the girl, she has no history. Her parents are out of the country and unless social work can track them down, we have no way of knowing if she really does have any sort of history with heart defects. She’s never had any sort of cardiac work-up, so we don’t have anything to go on.” She hands over a printed sheet with the typed history. “Until we get her test results, there’s not much we can do.”

Melendez scans the printout and hands it back to Claire. “Alright. Claire, take Jared and wait for the labs. I want the results the second they are ready. Murphy, we still can’t find an interpreter, so that’s your job. Make sure you’re in the room when the echo technician gets there. I don’t want any miscommunications screwing this up.” He looks at the readings in Claire’s hands one more time. “And up her oxygen. Her sats are still in the low 90s. I’d like her to be at at least a 95.” Shaun nods and takes off back towards the elevator while Claire and Jared head to the lab to play the waiting game.

-

Shaun enters Emily’s room along with the echocardiogram technician, a woman in her 30s named Sandra. He stands on the opposite side of the bed from Sandra so as not to get in her way.

“Hello. This is Sandra, she is going to do the echo.” Emily nodded and sat up.

“And you’re still playing interpreter. Don’t you have doctor-y stuff to do?” Her ‘Y’ after ‘doctor’ was exaggerated and she scrunched her nose a bit.

“Drs. Browne and Kalu are waiting for your labs. I am supposed to stay here until an interpreter can be found.” Emily nodded. “We don’t want any miscommunication that could affect your results.”

Shaun interprets as Sandra explains the process of an echo. She has Emily change into a paper shirt that can be easily accessed by the ultrasound, and explains that the lights must be dimmed during the actual test. Shaun adds, “The lights can be turned back on if either you or Sandra has something to say. That way, you can see my hands.” Sandra nods and smiles.

While the technician sets up, Emily makes an attempt at small talk. “So, why do you know sign language? Hobby? Foreign language credit?” Shaun shakes his head.

“My foster brother was deaf.” Emily waits, expecting more from the story but soon realizing that’s it. Sandra leaves to find more ultrasound gel, and Shaun forgoes voicing for Emily while she’s gone.

“That’s neat. Did he teach you? My parents made my brother go to a special class when he was little, because they didn’t trust me to teach him anything but the bad words.” She giggled, her laugh high-pitched. Shaun wondered what her voice might actually sound like. If it was anything like her laugh, then she probably sounded a bit like a pixie.

“Yes, Adrian taught me. I wish he taught me more, but I only lived there 6 months. After that, I learned from textbooks in case I ever went back to live with them.” He swayed a bit and rang his hands. “I missed signing.” He looks to the floor before remembering that eye contact, or something very close to eye contact, is required with sign language. One of many reasons why non-verbal autistics use AAC instead of signing; Shaun learned this from the Internet and always wondered why so much of ASL was done on the face.

“Why don’t you sign more, then? I mean, from what I can tell, you have a nice voice, but signing is always fun!” She flicked her first two fingers from her nose to form an ‘X’ shape with her non-dominant hand. Shaun started to sign a response before Sandra came back with a new bottle of gel.

-

Jared rushed towards the group with several papers in his hand. “We got the lab and echo results!” 

Melendez looked up and reached for the sheets, “Well, let’s see them!” He began scanning the numbers as Jared explained the findings. 

“Her white count is through the roof. I’ve never seen anything that high.” Claire looked confused.

“But she doesn’t have an infection. Her lungs sounded clear, her fever was only slightly elevated, and other than the shortness of breath she said she felt fine.” She tried to look over Melendez’s shoulder to see the results, but he held them away.

“And yet, there’s this.” He held up an image from the echo up to the light. Claire whistled lightly.

“Damn. What kind of mass is that? Vegetation?” She took the image from her attending to get a better look. “It looks like infective endocarditis.” Jared took the image while Melendez explained the rest of the results.

“That’s because it is. Looks to be chronic; she probably has been having problems breathing for a while now, but she’s young and otherwise healthy so she never went to the doctor. Luckily, it looks slow growing, so surgery isn’t necessary yet. We can run some antibody tests to see what exactly we’re working with, then hopefully a few weeks of antibiotics will completely cure her.” He shuffled some of the papers and leaned over the nurse’s station to grab a lab form. Claire wasn’t satisfied with the answer.

“What about the murmur? Endocarditis doesn’t cause a heart murmur.” She grabs the CBC results, looking for anything out of the ordinary, other than the white blood cell count.

Melendez looks frustrated. “We can’t do anything about the heart murmur until we can treat this infection. Most likely, the murmur is just a congenital abnormality that has been there for years and has never caused an issue.”

Claire stood her ground. “If the infection was caused by a heart condition, then even if we start treatment for the infection, she isn’t going to get better until we treat the underlying issue.”

While the two argue, with Jared attempting to have his opinion heard (he thinks they should go ahead and start the girl on antibiotics), Shaun grabs the echo images and holds them up the light one by one. He then gets very excited and holds one fist in the air.

“There!”

Claire and Melendez stop their argument and turn to look at him. Melendez raises his eyebrows and puts his hands on his hips.

“There’s nothing there except the infection. The radiologist already did her report, and all of us here looked at it too. The heart murmur is probably completely innocuous.” Shaun shook his head vehemently.

“No, no. Look there. At the ductus arteriosus.” He held the image so the others could see. Jared snatched the photo and held it up closer to his face.

“It’s intact.” He turned the image a little to get a better angle before Melendez snatches it himself.

“A patent ductus arteriosus? In an eighteen year old?” He stared at the echo in silence for several long moments before pointing to the very small defect on the scan. “No, I see it now, but I don’t understand how this went unnoticed. Every infant goes through multiple tests to make sure this doesn’t happen.” He continued to stare at the picture, amazed that he was seeing this defect in someone so old. Claire flipped through some of the patient’s paperwork that had been printed alongside the lab results.

“It says here that she was a home birth. Maybe she just didn’t have a good pediatrician? Someone not familiar with new infant check-ups could potentially miss this. And then as she got older and didn’t speak, everyone was so focused on her developmental disability that they didn’t notice her heart was messed up too.” Claire slipped the papers back into their folder and waited for Melendez to be done with the scan before placing the images in their sleeve.

Melendez cleared his throat. “Okay, well even if she has a PDA, we can’t fix it until this infection is completely clear. Jared, I want you to order another echo. I want to be there for this one so I can see exactly what we’re dealing with. Pending the new lab results, let’s go ahead and get her started on ceftriaxone. That will hopefully clear the vegetation enough that I can get a better look. Claire, see if social work has located Emily’s parents yet. I want to know every bit of her history, including the pediatrician who first evaluated her. Let me know as soon as you get in contact with them. And Murphy,” he sighs slightly, “I guess you’re with me. I need to tell Emily what we’ve found, and the emergency interpreter is still with the cancer patient upstairs.” Shaun bounced on his heels a little before following Melendez to Emily’s room.

-

Emily’s door was closed, so Melendez rapped on the door a few times before entering. Emily glanced up as the two doctors entered the room and sat up a bit in the bed. Shaun again took his place at the front of the bed so he could interpret both sides of the conversation. The girl waved and then pointed at Melendez. 

“You’re new.” She studied him for another moment before looking to Shaun like he had the answers. Instead, Melendez started talking.

“I’m Dr. Melendez, I’m the attending on your case. I’ve reviewed your test results and we finally have some answers.” Even though he used a somber voice, and Shaun tried to mimic this in his signing, Emily still looked delighted. She sat up fully in the bed, pulling her legs under her to sit criss-cross. She clapped her hands a little before beginning to sign.

“Oh good! Does that mean I can go home soon? I’m feeling better.” She looked hopeful, and Melendez exchanged a short glance with Shaun before continuing.

“Well, you won’t be going home for a little while. The echo and labs indicate that you have infective endocarditis.” He waited for Shaun to finish spelling out the words, as he was having some difficulty separating the letters. “It’s an infection around your heart. You’ve likely had it for a while; it looks like it’s been there for at least a few weeks, if not months. Are you sure this is the first time you’ve had shortness of breath?”

Emily waited for Shaun to finish signing before looking down guiltily. She took in a deep breath and let it out slowly. “I’ve had some difficulty getting up and down the stairs recently, and I’ve had to use my roommate’s inhaler a few times when it got bad.” Melendez raised his eyebrows. “But my parents don’t have very good insurance! It only covers like one GP visit a year and a couple sick visits, and I already used them up when I had the flu. I didn’t think it was that big of a deal.” She threw her hands in the air a little and shrugged when she was done. Melendez looked at his chart again before placing the clipboard on the table.

“Well, the good news is that this is completely treatable. We are going to start you on IV antibiotics, which you’ll need to be on for four weeks.” Emily sat up straight and began signing ‘no’ and shaking her head. “The goal is to have you out of here within the next week. We’ll put a temporary port in your arm and a nurse will train you in giving the antibiotics to yourself. We will still need you to come in once a week for an echo until this clears, but hopefully you’ll be able to go home.” Emily’s face breaks out in a grin once Shaun signs ‘home’.

“So, that’s it? That’s what was causing that thing, the-” She signed the letter ‘m’ and waved her hands around a bit, pointing to her chest. 

Shaun helpfully supplies, “The murmur,” and Emily nods. “The infection did not cause your heart murmur.” Emily looks confusedly at Shaun first, and then Melendez. Shaun speaks again, “Your murmur was caused by a congenital heart defect called patent ductus arteriosus.” Emily seemed to lose focus halfway through Shaun’s spelling.

“Okay, well I’m going to need that in writing. Even my brain can’t follow that many letters.” She smiled and Melendez chuckles a bit.

“I’ll make sure we give you a patient brochure with all of the information. This defect is very rare in adults since it’s usually detected at birth, so we’re trying to contact your parents right now to get some more information. Dr. Browne believes that it was an oversight by your pediatrician since they were probably more focused on your communication disorder.” Emily nods. “Right now, nothing can be done about the defect, but once your infection clears up I’d like to see you back here. We will do an evaluation at that time, but I believe we can perform a noninvasive surgery to fix the defect and hopefully prevent another infection like this from happening.” Emily waits for Shaun to finish signing and then looks back at Melendez. She signs a simple ‘thank you’, which Melendez definitely understands but Shaun interprets anyway. 

Melendez moves to leave the room, gently touching Emily’s shoulder and nodding before turning. Shaun moves to follow him but is startled by Emily reaching out to stop him.

“Sorry, I didn’t mean to scare you.” Her ‘sorry’ is over exaggerated and she moves her whole body to sign ‘frighten’. “I just wanted to thank you for being a makeshift interpreter. I know you have more important doctor things to do than stand here and talk to me all day.” Shaun hums under his breath, but Emily gets enough of the sound that she giggles. “Also, it’s obvious you haven’t signed in a while, but you’re still pretty good. If being a doctor ever falls through, you could always be an interpreter.” She scrunches her nose to indicate that she’s joking, but Shaun is more focused on her hands than her face and doesn’t notice.

“It won’t. I’m going to be a doctor for at least forty more years. Then I can retire and have a big TV.” Emily laughs and covers her mouth with her hand before signing again.

“That’s a good plan. Anyway, thank you. Maybe I’ll see you again when I come back? I mean, hopefully I’ll have a real interpreter by then; the nurses are getting a little fed up with me just pointing at things.” 

“Okay.” Shaun bounces on his heels and glances towards the door, knowing Melendez is probably wondering where he is by now.

“Alright. Goodbye Dr. Murphy.” Emily waves and Shaun nods before leaving the room.

**Author's Note:**

> Some notes: I am autistic, but no person's autism is the same so I write based only on my experiences, not anyone else's. I also know and use American Sign Language, and minor in Deaf Cultural Studies, and I have Auditory Processing difficulties, though not at the same level as Emily. As I wrote, I signed every single sentence that would have been signed, because I wanted to be able to get a good feel for how the conversation would have looked, so I hope that translated over well. I also did an extreme amount of research for this fic because I wanted everything to be perfect, but I'm not a doctor so it's possible I got something wrong. If so, please correct me!
> 
> As always, feel free to critique my characterization, grammar, etc because I'm always hoping to improve.
> 
> Thanks for reading!
> 
> Another side note: It is my headcanon that Shaun spent at least a year in foster care since I don't think Glassman adopted him, so feel free to discuss this in the comments!


End file.
